Streamlining Newcastle Upon-Tyne's Acute Frailty Team

Introduction: The expansion of acute frailty services is essential to meet the 
needs of our ageing population. According to the UK Office for National Statistics 
2021 census, over one-sixth of the population (18.6%, or 11.1 million people) 
were aged 65 and over, with this proportion expected to rise to 25% within the 
next 20 years.

Acute Frailty Team (AFT) was introduced in Newcastle in December 2024, aiming 
to create a streamlined pathway to avoid unnecessary admission and improving 
supportive discharges, the first frailty team in North-east England. The second
audit cycle shows a decrease in inappropriate referrals, increased discharges,
and less admissions.

Methods: Data was collected January-August 2025 on patients referred to the 
AFT. A traffic light system was used for analysis: green for assessments 
completed by AFT, amber for completion within 72 hours of admission, and red 
for incomplete assessments. Audited areas included CFS, 4AT, NEWS, 
functional assessments, discharge planning, onward referrals, and 
admission/discharge status.

Results: 1291 patients reviewed. 

CFS completed by AFT=77%, ED=44%, not documented=443. CFS 6 most 
common admission, CFS 5 most common referral. Reviews from AFT 58%, IDT 
reviews 42%. 55% admitted, 45% discharged, previously 69% and 31%.16 to 
zero inappropriate referrals over 8 months. Triple assessment completion nearly 
100% by August. NEWS 2 most common

Conclusion: By improving the consistency of CFS documentation in ED, as well 
as standardising functional assessments, streamlines management of elderly patients. The data suggests that a more structured triple 
assessment can avoid admissions to assessment suite and minimising time 
spent in the ED. Future training efforts should focus on embedding the triple 
assessment into routine practice, ultimately optimising patient flow, improving 
care outcomes in elderly patients.